Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Job Summary :
Performs utilization review with external agencies to ensure payment for medically necessary inpatient services.
Essential Functions :
Minimum Qualifications : Bachelor’s degree or commensurate experience in a related field of Psychology or Utilization Review.
Completion of Handle with Care Basic Certification in physical and nonverbal patient management within two months of hire with annual re-certification.
Knowledge, Skills & Abilities : Master’s degree in Psychology, preferred. Previous experience with utilization review, case management or telephone triage desired.
Familiarity with electronic medical records and medical terminology.
Physical Requirements : Constantly sit, see / visual acuity, handle / grasp / feel, talk / hear, lift / carry 1 to 25 lbs.
Frequently stand, walk, reach, bend / twist, lift / carry 25 to 49 lbs. Occasionally lift / carry 50 lbs.
Last updated : 2024-03-23
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